糖代谢异常对原发性高血压患者肾脏微血管病变的影响  

Influence of impaired glucose metabolism on renal microvascular injury in essential hypertension Patients

作　　者：王钢[1] 

机构地区：[1]广州军区广州总医院老年病房一科,广东广州510010

出　　处：《临床军医杂志》2015年第1期44-46,共3页Clinical Journal of Medical Officers

基　　金：广东省医学科学研究基金(A2009490)

摘　　要：目的探讨糖代谢异常(IGM)对原发性高血压(EH)患者肾脏微血管病变所致的肾功能损伤的影响。方法检测并对比46例单纯EH患者[平均年龄(77.1±5.6)岁]与36例合并2型糖尿病(T2DM)EH患者[平均年龄(79.3±5.9)岁]之间的血糖、血脂参数及血清同型半胱氨酸(Hcy)、胱抑素C(Cys C)、尿微量白蛋白(UM)浓度差异,同时分析血糖参数、血清Hcy、Cys C及UM浓度之间的相关性。结果与单纯EH患者相比,合并T2DM的EH患者的BMI、空腹血糖(FBG)、餐后2 h血糖(PBG)、糖化血红蛋白(Hb A1c)、血三酰甘油、低密度脂蛋白胆固醇、载脂蛋白B、尿酸及纤维蛋白原等代谢参数均显著高于单纯EH患者(P<0.05),而且血清Hcy分别为(16.35±2.86)μmol/L与(12.59±2.37)μmo/L,P<0.01;Cys C浓度(1.40±0.30)mg/L与(1.02±0.16)mg/L,P<0.01及UM水平(3 3.0 8±1 0.5 5)mg/L与(19.40±5.22)mg/L,P<0.01,也均显著增高;相关分析显示,在合并T2DM的EH患者中,血清Hcy浓度分别与FBG(r=0.645,P<0.01)、Hb A1c(r=0.652,P<0.01)正相关,UM也分别与FPG(r=0.387,P<0.05)、Hb A1c(r=0.635,P<0.01)正相关;而且,血清Hcy与Cys C浓度(r=0.841,P<0.01)、血清Hcy浓度与UM水平(r=0.655,P<0.01)、血清Cys C浓度与UM水平之间(r=0.479,P<0.01)均显著正相关。结论 IGM加重EH患者肾脏微血管病变,影响肾小球滤过功能,改善其血糖代谢可有助于延缓肾微血管病变的发生并进展至肾功能不全阶段。Objective To explore vascular endothelial dysfunction induced by the coexistence of impaired glucose metabolism in es- sential hypertension （EH） patients. Methods Comparative assessment on body mass index （BMI） , blood glucose, blood lipidogram, urinary microalbumin （UM）, serum homocysteine （Hcy） and cystatin C （CysC） were made between 46 （average age 77.1 ±5.6 years old） simple EH and 36 （ average age 79.3±5.9 years old） EH with Type 2 diabetes mellitus （T2DM） patients, which were followed by correlation analysis in those combined with T2DM. Results In comparison to the simple EH patients, those with T2DM had significantly higher level of BMI, fasting blood glucose （FBG） , postprandial blood glucose （PBG） , glycosy- lated hemoglobin A^c （ HbA~ c） , triglyceride （TG） , low dense lipid-cholesterol （LDL-C） and apo-B （ P 〈 0.05 ）. Besides, the levels of serum Hcy （16.35 ±2.86 vs 12.59±2.37μmol/L, P 〈0.01） , CysC （1.40±0.30 vs 1.02±0.16 mg/L, P〈0.01） and UM （33.08 ± 10.55 vs 19.40 ± 5.22 mg/L, P 〈 0.01 ） were also significantly higher in those with T2DM than in the simple EH patients. Correlation analysis performed in those combined with T2DM revealed that serum Hey was positively related with FBG （ r = 0. 645, P 〈 0.01 ） , HbA1 c （ r = 0.652, P 〈 0.01 ）, and that UM was also positively related with FBG （ r = 0.387 ,P 〈 0.05 ） and HbAI c （ r = 0. 635, P 〈 0.01 ）. In addition, the correlation between serum Hcy and CysC （ r = 0. 841 ） , serum Hcy and UM （ r = O. 655） , serum CysC and UM （ r = 0. 479） all reached statistic significance （P 〈 0.01 ）. Conclusion Impaired glucose metabo- lism may aggravate the renal mircovascular disease in EH patients, which in turn leads to renal glomerular filtration inefficiency. Therefore, improvement in glucose metabolism helps to alleviate the renal microvascular injury and retard the pathological progress towards inefficiency of renal function.

关 键 词：糖代谢异常 原发性高血压 肾脏 微血管病变 

分 类 号：R544.1[医药卫生—心血管疾病]